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									<li><a href="#">Home</a></li>
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				<a class="sal" href="">SAVE A LIFE</a>
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							SPONSOR<br/> A CHAZZAK<br/> SUPPORT<br/> GROUP
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							SPONSOR<br/> A CASE
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							GENERAL<br/> DONATION
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			Chazack groups is changing lives everyday, be part of it!
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				Choose your kind donation
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				<a href="">$18.00</a>
				<a class="active" class="" href="">$36.00</a>
				<a class="" href="">$50.00</a>
				<a class="" href="">$100.00</a>
				<a class="" href="">$180.00</a>
				<a class="" href="">$360.00</a>
				<a class="" href="">$580.00</a>
				<a class="" href="">$1,000.00</a>
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					<span class="dolr">$</span>
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				Your donation can save a life
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						&nbsp;
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							Todays Donation
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						<div class="amount">
							$36.00
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								Recurring<br/> Monthly<br/> Donation
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								Contribute<br/> Anonymously
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							Donor Information
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								<input type="text" class="form-control error imp" placeholder="First Name">
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								<input type="text" class="form-control error imp" placeholder="Last Name">
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								<input type="text" class="form-control imp" placeholder="Address">
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								  <option>State</option>
								  <option>State 1</option>
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								  <option>Country</option>
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								<input type="text" class="form-control imp" placeholder="Zip">
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								<input type="checkbox"></input> My billing address is the same as above
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							Billing Information
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								<input type="text" class="form-control imp" placeholder="First Name">
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								<input type="text" class="form-control imp" placeholder="Last Name">
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								<input type="text" class="form-control imp" placeholder="Address">
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								<input type="text" class="form-control imp" placeholder="City">
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								  <option>State</option>
								  <option>State 1</option>
								  <option>State 2</option>
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								  <option>Country</option>
								  <option>Country 1</option>
								  <option>Country 2</option>
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								*Required Field
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							ABOUT US
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							When faced with any form of medical challenge, big are small, patients and their caregivers are able to rest assured with the knowledge that guidance, a listening ear, experienced and expert advice are just a phone call away. 
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							LINKS
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							<li><a href="">Services</a></li>
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							Subscribe to our monthly newsletter and Tehilim list. We will not share your email in any way.
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						&copy; Copyright 2015 Refuah Helpline
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